Use the labels in the right column to find what you want. Or you can go thru them one by one, there are only 14807 posts. Searching is done in the search box in upper left corner. I blog on anything to do with stroke.DO NOT DO ANYTHING SUGGESTED HERE AS I AM NOT MEDICALLY TRAINED, YOUR DOCTOR IS, LISTEN TO THEM. BUT I BET THEY DON'T KNOW HOW TO GET YOU 100% RECOVERED. I DON'T EITHER, BUT HAVE PLENTY OF QUESTIONS FOR YOUR DOCTOR TO ANSWER.

Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all thetrillions and trillions of neuronsthatDIEeach daybecause there areNOeffective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.My back ground story is here:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

BOSTON – A post hoc analysis of the
Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-2)
trial showed hints of benefit to lowering blood pressure in patients
presenting with brain hematoma, but even the new secondary analysis did
not produce significant findings, researchers said here at the annual
meeting of the American Academy of Neurology.
About 18% of patients assigned to intensive blood pressure treatment
-- keeping systolic blood pressure between 110 and 139 mm Hg -- had
increases in hematoma volume compared with 24.4% of the patients who
were in the standard therapy group and whose blood pressure was
maintained between 140 and 179 mm Hg, said Adnan Qureshi, MD, professor of neurology at the University of Minnesota, Minneapolis."That
certainly looks like it is going in the right direction," Qureshi said
in presenting the secondary analysis of the trial that was halted for
futility. Qureshi and colleagues were attempting to find out why the
trial failed to produce evidence that intensively lowering blood
pressure would benefit patients by reducing the size of expanding
hematomas, and therefore producing less disability.
The deep dive into the data found some trends to benefits: fewer
patients with intensive blood pressure control had more than a 33%
increase in the size of the hematomas; more of the intensively treated
patients had better control of larger hematomas; there appeared to be a
numerical benefit in disability measures. But overall, Qureshi said,
none of those secondary analyzes reached statistical significance.
He said there were at least two main explanations for the failure of the trial.

One, there were many very small hematomas which
might have made showing a difference difficult. Overall, 450 patients
were assigned to intensive blood pressure control and 426 patients were
assigned to standard treatment. But just 221 of the intensively treated
patients presented with hematomas of 10 cm or greater and 217 of the
standard treated patients had these large hematomas. There was a trend
to better control of these hematomas in the intensively treated patient
group.

ADVERTISEMENT

ERBITUX® (cetuximab) - Physician Website

View Safety & Prescribing Info Including Boxed Warning. HCP Site.

www.erbitux.com/hcp

Two, Qureshi said that in practice most of the standard-treatment
patients had blood pressure controlled at below 160 mm Hg, and they
represented what could be considered a "pseudo crossover" patient.
"Virtually all patients in this trial had blood pressures reduced to
less than 160 mm Hg in both arms so once you get a person below 160 mm
Hg, there isn't going to be much benefit to be gained. It is possible
that any real benefit would have been achieved by keeping blood pressure
below 160 mm Hg in any event," he said.The
original trial was proposed to enroll 1280 patients, but it was halted
for futility after 100 patients were enrolled. Qureshi analyzed those
patients for whom complete data were available. The mean systolic
pressure at enrollment was 200.6 mm Hg. Their mean age was 61.9 years;
56.2% of the cohort were Asian. In the primary outcome 38.7% of the
intensive-treatment patients died or were disabled compared with 37.7%
of the standard-treatment patients. The rate of renal adverse events
within 7 days after randomization was significantly higher in the
intensive-treatment group than in the standard-treatment group (9.0%
versus 4.0%, P=0.002).
The goal of treatment was to reduce and maintain the hourly minimum
systolic blood pressure in the range of 140 to 179 mm Hg in the
standard-treatment group and in the range of 110 to 139 mm Hg in the
intensive-treatment group throughout the period of 24 hours after
randomization. No effort was made to conceal the treatment assignment
from the participants or treating physicians.
Qureshi noted, "We have a change that appears to be affecting our
biomarker – expansion of the hematoma. And a biomarker that is linked to
disability. So why didn't we get the result we wanted? It may be that
we need to lower blood pressure further. We must need a bigger change in
expansion to have an impact on outcomes."
There are no plans at the moment to continue this line of investigation, he said.
"We have learned from the ATACH studies that these are hard things to do," commented Natalia Rost, MD,
director of the Acute Stroke Service at Massachusetts General Hospital,
Boston. "Stroke is complicated and we keep missing the targets on both
the cutoffs and on the use of markers. We use intermediate markers such
as what we see on an image. But we don't have evidence that these
markers are perfect. But I think we may be making some progress.In the ATACH trial, Rost told MedPage Today,
"I think there probably was a cutoff that wasn't tested – the 160 mm
Hg, but there is a good indication that might be a good cutoff for
effectiveness. I think this is one reason we keep missing the target –
we aim either too high or too low. So 160 mm Hg sounds reasonable, but
we do not have class 1 evidence.
"We usually try to lower the blood pressure in patients who present
with hematomas and often we try to get blood pressure under 140 mm Hg,
but I don't think doctors should get too flustered if the patients is
around 160. If they are over 180 mm Hg I would be very worried and I
would want to treat them to lower blood pressure," she said.

No comments:

Post a Comment

Total Pageviews

Top 25 stroke blog

email me

Ask Dean
Any local survivors close to East Lansing, drop me a note and we can have coffee sometime.
Questions or comments or would you like me to discuss something? I will try to answer, No medical diagnosis given or received. I am damned opinionated so don't expect fluff.

Copyright

Canoeing Moose

Just because my goal is to get back to canoeing and this moose is so ripped and cool looking. And he's even a solo paddler. But his right hand on the T-grip is wrong and the right arm should be extended.